1. Presented to Methodist West Houston
Nursing Grand Rounds
by:
Celinda Zwerneman, RNC-OB, BSN
Liz Ozkan, RN, LCCE, IBCLC, RLC

2.  Celinda Zwerneman, RNC-OB, BSN
 Birthing Center Staff Nurse
 Liz Ozkan, RN, LCCE, IBCLC, RLC
 Birthing Center Lactation Consultant/Education
Coordinator

3. Skin to skin contact (SSC) in the first hour after birth is
crucially important to EVERY baby and mom.
 WHO/UNICEF
 Baby Friendly Hospital Initiative
 Ten Steps to Successful Breastfeeding
 AAP Guidelines
 Healthy infants should be placed skin-to-skin
contact with their mothers immediately after
delivery until the first feeding is accomplished
 American Heart Association
 Neonatal Resuscitation Program (NRP)

4.  “The first hour of life outside the womb is a special time when a
baby meets his or her parents for the first time and a family is
formed.
 This is a once-in-a-lifetime experience and should not be
interrupted unless the baby or mother is unstable and requires
medical resuscitation.
 It is a “sacred” time that should be honored, cherished and
protected whenever possible.”
(Phillips, 2013)

5. 16% of neonatal deaths could be saved if all infants were
breastfed from day 1 and 22% if breastfeeding were started
within the first hour after birth”
(Edmond et al, 2006)
 Warmth
 Comfort
 Metabolic & bacteriological
adaptation
 Quality of attachment
Dr. Jack Newmann, 2005

6. expulsion of
placenta and
reduction of
post partum
hemorrhage
massage of
the breast by
the baby
subsequent
suckling
large oxytocin
surge from
the mother’s
pituitary
gland
Oxytocin
helps contract
the uterus
expelling
placenta and
closing off
many blood
vessels in the
uterus
reducing
blood loss
and
preventing
anemia
pressure of
the infant’s
feet on the
abdomen
may also
assist in
expelling the
placenta
Klaus and Kennell, 2001

7.  Bonding (Moore et al, 2012):
 Mother-infant separation post-birth
is common in Western culture
 Early skin-to-skin contact (SSC)
begins ideally at birth and involves:
 placing the naked baby, head
covered with a dry cap and a
warm blanket across the back,
prone on the mother's bare chest
 According to mammalian
neuroscience, the intimate contact
inherent in this place (habitat)
evokes neurobehaviors ensuring
fulfillment of basic biological needs
 May represent a
psychophysiologically “sensitive
period” for programming future
physiology and behavior
Dr. Nils Bergman Video

8.  “…increasing the mother-infant time together or increased
suckling improves caretaking by the mother” (Klaus and
Kennel, 2001)
 If the lips of the infant touch the mother’s nipple in the first
hour of life, a mother will decide to keep her baby 100
minutes longer in her room every day during her hospital
stay than another mother who does not have contact until
later (Widstrom et al, 1990)
 Helps prevent parenting disorders including child abuse,
failure to thrive, abandonment and neglect later on

9.  Patient was unsure of breastfeeding and stated
“ I am fearful that it will not even work”
 Patient Background/Assessment
 28 year old white female
 Delivered vaginally at 40 weeks gestation
 Uneventful delivery
 Unremarkable health history
 Attended breastfeeding class at MWHH a month
before delivery
 Vitals WNL

10.  Nursing Diagnosis:
 Knowledge deficit r/t breastfeeding AEB interpretations
of misinformation
 Anxiety r/t breastfeeding AEB verbalization of fear and
uncertainty
 Patient/family challenges to initiating SSC
 Visitors
 Hospital policies
 Time limits
 Nurse education (lack thereof)
 Cultural beliefs
 Patient comfort

11.  Intrapartum and postpartum education and
reassurance for patient and her husband
 Breastfeeding Class that includes education on
SSC
 Assisted with initiation of immediate SSC
 Infant latched on and nursed well

12. “Breastfeeding is going really well. Charlotte was 7lbs 3oz at
her first pediatrician apt on Friday and the doctor was really
pleased with that since she was 6lbs 11oz when she was
born last Monday. She latches immediately every time…I
really think a lot of our success is from what we learned in
the breastfeeding class we took with Celinda and with her at
the hospital. Please pass that on to her because it was really
helpful and informative.”

13. Klaus MH, Kennel JH (2001) Care of the parents in 'Care of the high-risk neonate',
5th edition, W. B. Saunder's Company: 195-222.
Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for
mothers and their healthy newborn infants. Cochrane Database of Systematic
Reviews 2012, Issue 5. Art. No.: CD003519. DOI:
10.1002/14651858.CD003519.pub3
Newmann, J. (2009). The importance of skin to skin contact. Retrieved from
http://www.nbci.ca/index.php?option=com_content&id=82:the-importance-
of-skin-to-skin-contact-&Itemid=17
Phillips, R. (2013) The sacred hour: uninterrupted skin-to-skin contact
immediately after birth. Newborn and Infant Nursing Reviews. 13(2), 67-72.
doi:10.1053/j.nainr.2013.04.001
Svensson KE, Velandia MI, Matthiesen AST, Welles-Nyström BL, Widström AME
(2013) Effects of mother-infant skin-to-skin contact on severe latch-on
problems in older infants: a randomized trial. International Breastfeeding
Journal, 8:1 doi:10.1186/1746-4358-8-1
Widström, A. M., Wahlberg, V., Matthiesen, A. S., Eneroth, P., Uvnäs-Moberg, K.,
& Werner, S., et al. (1990). Short-term effects of early suckling and touch of the
nipple on maternal behavior. Early Human Development, 21(3), 153–163